Hair4Days

This isn’t my head. It’s an example i found from a YouTube video showing the application of hair fibers. I’m pointing out that he has deep lower crown loss and hair from the hairline -> top of the crown which looks outrageous. My argument would be to Graft the lower crown instead of the upper crown if you had to decide between the two.

2 hours ago, Rahal Hair Transplant said:

Hair4Days,

While there are exceptions to every rule, in my personal opinion, I think it’s always better to graft from front to back recreating as natural looking of a hairline as possible and then covering as much as possible in the back.  

In an advanced case of balding such as a Norwood class 6, there will very likely be thinning in the lower crown area above the occipital ridge.  But, since donor hair is limited and it would be unlikely to cover the entire balding area while re-creating any level of density, the surgeon must evaluate what’s going to create most cosmetic improvement.

While I understand the argument that leaving balding/thinning in the lower crown area may look unnatural with a restored frontal and mid scalp region, the truth is, the vast majority the population wouldn’t notice.

In other words, I don’t think many people are aware that those with thinning  in the lower crown are also typically bald in the front. Allow me to explain  

Most likely, only hair gurus such as veteran hair transplant patients and hair restoration surgeons would even blink if they saw a gentleman with a relatively full looking head of hair but with thinning or baldness in the lower crown area.  The vast majority the population wouldn’t even know that this isn’t a natural way to lose hair  

Ironically, I fit into the above scenario. I have a pretty full looking head of hair with essentially no signs of balding in the frontal and mid region of the scalp and only mild thinning in the crown. But if you look at the back of my head, you can see thinning in the lower crown region as well.  Frankly, nobody has  questioned this or looked at me funny. Most people that I’ve spoke with didn’t even notice the thinning in the back and those that did, just assumed that I thinned out in that area naturally  

Now let’s consider the opposite. Let’s say that an individual feels that it would look unnatural with a full looking hairline in the front and mid scalp regions but with baldness or thinning in the lower crown area. So as a result, The surgeon starts from the back and works their way forward.  At best, the surgeon will likely get to the midregion of the scalp and never even touch the hairline.  While it would certainly look natural according to the Norwood scale the hair loss, The vast majority the population will conclude that this individual is bawled rather than possessing a relatively full head of hair.  

Long story short, people notice individuals from the front a lot more than they do from the back. Somebody with a relatively youthful looking hairline and some thinning or even baldness in the crown would be considered to have a lot more hair from a cosmetic standpoint than somebody with no signs of thinning in the crown and a substantially recessed hairline.

Thus, my opinion remains that it is far better that surgeons take the approach of grafting from the front to the back.

Best wishes,

Rahal Hair Transplant 

Thank you for the detailed response. Much respect. I am on board with grafting starting from the hairline and working back as the front should be everyone’s priority. What I’m mainly referring to in this hypothetical, is a client with an advanced pattern with complete deep lower crown loss. ( more of that horse shoe look where the lower crown has that ring look. ) At times, surgeons will relay that patients must compromise on density in the crown, if any grafts at all. I was curious  if it would be a better idea to implant those grafts in the lower crown, instead of the upper crown on top of the scalp. You see more bald spots in the top of the crown ( see Manu Ginobli) than you do in a lower crown region that will have that ring ‘swoop’ effect. With the lower crown grafted (after the  hairline and midscalp is taken care of of course), you will have the opportunity to slick your hair back and cover that upper zone easily. I do agree this must be considered once your hairline & midscalp is already worked on. I will show an example of a photo showcasing what i mean by hair everywhere except the lower crown looking odd. Let me know 

In a hypothetical scenario.. if a Norwood 6 or 7 with a weak/limited  donor undergoes surgery, would anymore make the argument to graft the lower crown over the upper crown? I feel like if you graft front to back, leaving the lower crown open and exposed, it would look unnatural As that’s not how balding typically looks. However, you do see isolated upper crown loss everyday. Thoughts on this strategy?

Supposedly 40 g per sq cm on average will have the visual of no thinning. I’ve also heard 30 could satisfy a majority of patients. During a consult  I’ve been told my mid scalp (which is the thickest area of my hair) is probably around 30. My mid scalp, to me, is 100% acceptable at this current time, so to have that all over i personally would be satisfied. 

That’s 3 for bloxham👏🏼 Wonder if he’d participate in the podcast 

You should try getting Dr. Bloxham. And get his take on why he  believes, to this day, that  FUT is not only better, but substantially superior to FUE. There’s still doctors out there that very highly advise against FUE for anyone beyond a NW3 and it would be interesting to hear why specifically 

I’m hoping for something more. Eugenix is well known for their successful Norwood 6 / 7 cases and I’m curious as to how exactly they determine candidacy for these type of cases. If it’s all visual, what’s the difference between them and other clinics and why are they so good at high nw surgery? 

I am booked this incoming week for an in person consult with the founders of Eugenix Dr Sethi & Arika. I am happy to have the opportunity to meet with them in person to have my case evaluated in person. In my experience with US based surgeons, the consults are mainly based on visual assessment. Minimal tools used to check for projected Graft count or donor miniaturization. -a borderline rushed experience. Considering i am a future Norwood 6 with a good beard, I’m curious how eugenix will go about the evaluation. Does anyone have input on the differences between consults done in the US vs eugenix, or clinics in Europe? Also, what key questions should i be bringing up to Dr sethi/arika during the consult? 

Why would the effects be minimal and not lasting? Meds just hold onto the hair on top longer. Your donor is long lasting hair

What’s the best way to diagnose this? I personally taper my neck and temples when i get a haircut so it’s always lighter then the rest of my donor. I have a usb microscope to examine my hair, but is it better to use it when those areas are grown longer or is it okay to examine when it’s shaved down (to a number 1)? 

I feel like head to head comparisons are important. It helps making a crucial decision  slightly easier.. and we need all the help we can get.  

14 hours ago, ciaus said:

. Finasteride is more about helping to hang on to your middle and back crown areas in the back so you don't look ridiculous with a restored hairline and nothing behind it. 

 

 

Why would he have nothing behind a restored hairline? His donor looks pretty solid right now. He could probably get at least 3/4 of his scalp covered over 2 surgeries imo

Did Wesley say your donor was good enough to get the coverage you’d need if your balding pattern progresses further? If so, there’s nothing wrong with his suggestion of avoiding fut. i just had a consult with him and supposedly my donor is outstanding so fue was his recommendation to me as well. 

8 hours ago, NARMAK said:

. In fact, Hasson and Wong stuck with FUT for a long time till FUE got to a point they felt it had become superior for them to use on most patients. 

 

Did it really become superior or is it because it generates more money? He didn’t really touch on the lifetime graft count argument in that video. 

Have you had a previous ht? Your hair looks solid. Wouldn’t change it. 

What is everyone’s opinion on this clinic for an fue procedure? You hear their name being in the top of clinics, but don’t see tons of results on the forums. Their wait time is a year, which is obviously a plus. It’s easy to pass positive judgement on surgeons with many patient cases showing their journey,  since a majority of us are sold on results. But my thing is, if you know a clinic has a solid reputation, does it even matter you don’t come across that many patient updates on the forum? 

3900 with one strip?

1 hour ago, NARMAK said:

Again, hair loss and transplants aren't perfect. Even the best surgeons can't fully anticipate which is why taking medication or having hair loss be stable for some time is usually recommended so much. 

I mean, your argument was you’d look weird after native hair falls out after a transplant. I think the better surgeons plan for this. You can’t expect patients to be on finasteride for life.. In a perfect world you’d hold on to a majority of your native hair with medication if you can tolerate it. If not, get surgery without taking meds. You’d need to cover more real estate and may not be able to get your crown worked on if your donor is poor, but that’s the compromise. Doesn’t mean you shouldn’t get a Ht if you don’t take finasteride. We see it here everyday  

4 minutes ago, NARMAK said:

Because if a person hypothetically gets a transplant where their current hair is amongst the native hair, in 10 years if all those hair are lost to male pattern baldness, you have a bunch of weirdly placed areas where your hair is. It will stand out like a sore thumb 

 

This is why you need a surgeon who knows how to strategically place grafts in zones that in the event your native hair falls out, the transplants can stand alone and look natural. Not random patches all over. It will look thinner no doubt, but hopefully not weird

7 minutes ago, ciaus said:

This guy has been doing minoxidil, finasteride, prp and he's still losing. Maybe he's getting close to losing all he's ever going to lose, but there's no way to know that especially at this very young age. Melvin said there's no point in a HT if the hair loss hasn't stabilized. The only ways its going to stabilize is by giving it time to play out, which this guy doesn't want to do, or responding well to medications, which this guy hasn't. And as far as realistic expectation go, this guy has already posted that he just wants to look young while he's still young, so that's missing from this scenario as well.

Even if he levels off at a complete Norwood 6, that doesn’t necessarily eliminate him from being a candidate of surgery without meds. That was my point. But yeah to stay looking youthful at 24 specifically, holding onto as much as possible is the easier route. Unless he committed to 2/3 surgeries over the next 5 years 

2 hours ago, Melvin- Moderator said:

You have aggressive hair loss for 24, probably headed towards Norwood 6 by 30. Are you on medication, there’s no point in getting a hair transplant unless you stabilize your hair loss first. Are you on finasteride? 

Why is there no point in a Ht unless he takes medication? There’s alot of people that chose not to be on fin and went ahead with surgery as long as expectations are realistic

Update. 

I’ve been on topical fin for a year now.  Zero difference. If anything, getting worse 

I’d go to someone who specializes in fue. 
 

how do your results look after 2 fut with bloxham? Will you post your update?

2 hours ago, Grouse said:

Thanks all! Yeah I was surprised how optimistic H&W and Eugenix were given my donor looks not great in harsh lighting + short. Maybe I'll optimize for an in person consultation first if at all possible.

 

Donor is thick and seems great when grown out a bit. But short and under direct lighting it seems not the best. 

 

Maybe I'll also reconsider doing topical Dut or something too... Thanks everyone!

Hair tends to always look a little more transparent when it’s cut shorter. Even for people with no hair loss. Mine is the same way. Grown out it’s super thick looking, but when i do a number 2 on the sides it looks thinner. Not sure at what length is a better  way to rate ones donor quality though. 

3 hours ago, 1978matt said:

It gives you something of a 'get out' assuming as you say that scarring is minimal in the donor. 

So say for instance you have two HTs totalling 4000 grafts, but hairloss gets the better of you long term, you can still buzz to a low grade and have decent facial framing from the frontal grafts.

You could then maybe have a small HT to tidy things up and cut your losses. 

This approach is underrated. It’s safe and doesn’t carry a whole lot of risk. Pro-FUT people would argue “you lose the ability to shave Going Fue as well” - which i don’t necessarily agree with. I’ve seen many donors that look untouched after fue. But that was at lower graft numbers. At 4K grafts I’m not sure how it would look.